Out-of-Network Health Insurance Dispute Resolution

      The bill makes changes to the dispute resolution process between health insurance carriers (carriers) and out-of-network health-care providers (providers) by requiring a carrier to provide, with each payment made to a provider, a remittance advice that:

• Identifies when the associated health benefit plan is regulated by the state and when the payment is made pursuant to services received from an out-of-network provider or at an out-of-network facility; and
• Provides the carrier's median in-network reimbursement rate for out-of-network claims.

       

• Mandating that a carrier provide a remittance advice with each payment made to a provider;

       

• Establishing penalties that the division of insurance (division) may assess against a carrier that fails to properly reimburse a provider for services provided to a patient;

       

• Requiring a carrier to annually submit information to the division concerning patient use of out-of-network providers; and

       

• Requiring the division to produce an annual report regarding patient use of out-of-network providers and relevant arbitration data and statistics.

(Note: Italicized words indicate new material added to the original summary; dashes through words indicate deletions from the original summary.)


(Note: This summary applies to the reengrossed version of this bill as introduced in the second house.)